2027 Mission Trip Registration - ADULTS

Chaperones are greatly needed and appriciated for our mission trip! Mission Trip Louisiana will be May 31 - June 5th, 2027. We will be traveling to Baton Rouge Louisiana and working with Catholic Mission Trips.

Young Adults 18-20 are NOT considered chaperones. The cost for non-chaperone young adults is $650. If you are 21+ and do NOT want to chaperone, you will need to drive yourself. You can arrange carpool with other young adults 18+.

Chaperones 21-24 are NOT considered Driver + Chaperone. Young adults between the ages of 21-24 may be considered a chaperone, and are welcome to drive themselves and young adults (18-20) but may not drive any high school teens. The cost for a chaperone that is not a driver chaperone is $550. In order to drive yourself you will need the proper form and safe environment approval from the Diocese. Please contact Lizzie Beauchamp (ebeauchamp@ourladyofangels.com) or Tara Ellwanger (tellwanger@ourladyofangels.com) to get form for your insurance.

Drivers + Chaperones must be 25+ in order to drive teens to Louisiana. You must have the insurance and approval from our Safe Environment office to drive teens. The cost for a driver chaperone $475. Please contact Lizzie Beauchamp (ebeauchamp@ourladyofangels.com) or Tara Ellwanger (tellwanger@ourladyofangels.com) to get form for your insurance.

Name

Address

This address will receive a confirmation email

Cell Phone

Secondary Phone

Gender

Male Female

Date of Birth

Age

18-20 21 or over

**Note: Young adults (18-20) may participate as part of a parish’s adult team for training purposes, but may not be counted as an official chaperone for the adult / youth ratio. The cost for a Young Adult NOT a chaperone is $650

Are you a parent of a youth participant?

Yes No

If yes, do you prefer to be with your child when possible or not? Please explain.

The mode of transportation for this trip is personal and/or rented vehicles which can, preferrably, carry 7 or 8 people. (12-15 passenger vans are NOT allowed)
Chaperones who are able to drive must be over 25. They will be charged $450
Chaperones 21+ who do NOT drive are charged $550.

Young adults 18-20 CANNOT be considered a chaperone.

Do you have a personal vehicle which can be used to transport teens and adults for this trip?

Yes No

If you answered "yes," how many seatbelts does your vehicle have?

Emergency Contacts

Main Emergency Contact Name

Main Emergency Contact Phone

Other Emergency Contact Name

Other Emergency Contact Phone

Medical Information

The information below is requested, but not required. It will only be used in the case of an emergency.

Insurance Carrier

Insurance Policy #

Insurance Phone Number

Name of Insurance Holder

Relationship of Holder to you

Please list below the names of medications taken on a regular basis:

Allergic reactions (medications, foods, plants, insects, etc.)

Immunizations (date of last tetanus/diphtheria)

Any disabilities or physical limitations

Any other special medical conditions

Consent to Participate & Liability Release

In consideration for allowing me to participate in this activity, I assume all risks and hazards incidental to my participation in the Event, including transportation to and from the Event. In consideration for allowing me to participate in the event listed above, and on behalf of myself and my parents, legal guardians, siblings, heirs, assigns, and personal representatives, I hereby release and agree to fully and unconditionally protect, indemnify, and defend the Parish, the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, “Indemnitees”) and hold each Indemnitee harmless from and against any and all costs, expenses, attorney’s fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons, and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to my participation in the Event, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES. In the event any legal action is taken by either party against the other party to enforce any of the terms and conditions of this release, it is agreed that the unsuccessful party to such action shall pay to the prevailing party therein all reasonable court costs, attorneys’ fees, and expenses incurred by the prevailing party.

I have read this consent & liability release, & I understand & voluntarily agree to its provisions.

Media Consent & Social Media Communications

On occasion, video recordings, audio recordings, photographic slides, and photographs are taken of children and youth during church and diocesan sponsored activities. These are utilized in newsletters, websites, event promotion, advertisements and other printed media. As the State of Texas does not prevent audio or video recording or the photographing of children/youth For good and valuable consideration, I hereby grant to Our Lady of Angels Catholic Church the irrevocable and unrestricted right to make, use and/or publish any and all photographs, videos, and other images of me/my minor child or images in which Student may be included, now existing or hereafter made, in any case, with or without identifying Student for editorial, advertising, news, or any other purpose and in any manner and medium; to alter the same without restriction; and to copyright the same. On behalf of myself and/or my child, I specifically waive all rights to privacy and confidentiality with respect to name, likeness, voice, photographs, images, video recordings, audio recordings and identifying information. I hereby release and agree to fully and unconditionally protect, indemnify, and defend Our Lady of Angels, the Roman Catholic Diocese of Dallas, and their respective officers, agents, and employees, (collectively, “Indemnitees”) and hold each Indemnitee harmless from and against any and all costs, expenses, attorney’s fees, claims damages, demands, suits, judgments, losses, or liability for injuries to property, injuries to persons (including Student) and from any other costs, expenses, attorney fees, claims, suits judgments, losses, or liabilities of any and every nature whatsoever arising in any manner, directly or indirectly, out of, in connection with, in the course of, or incidental to the use or publication of any photographs, videos, or other images of Student, REGARDLESS OF CAUSE OR OF THE JOINT, COMPARATIVE, OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES.

I have read this consent for Media Release, & I understand and voluntarily agree to its provisions.

Young Adult Expenses (18-20 OR NOT wanting to Chaperone)

Young Adults age 18-20 must be cleared to participate, but are not allowed to be chaperones or drivers. If you are 21+ but would NOT like to be considered a chaperone you may sign up as well but must be safe environment cleared. Therefore, your fee is $650.

Contact ebeauchamp, ebeauchamp@ourladyofangels.com, if you need balance due information.

Due January 9, 2027: $150 (Deposit)

Due February 5, 2027: $150 (Installment 1)

Due March 5, 2027: $150 (Installment 2)

Due April 9, 2027: $200 (Installment 3)

Total fee - $650

Payment for 18+ Years: If you are a young adult (18-20) OR a Chaperone + Driver please find your section to pay. Select

Non Driver Chaperones 21+

Chaperones age must be 21+ and safe nevironment cleared Therefore, the fee for them is $550.

Chaperone (21+)

Due January 9, 2027: $100 (Deposit)

Due February 5, 2027: $150 (Installment 1)

Due March 5, 2027: $150 (Installment 2)

Due April 9, 2027: $150 (Installment 3)

Total fee - $550

Payment for Non-Driver Chaperones (21+: NOTE - If you are not a chaperone please select $0 and see payment option above.

Driver + Chaperone Payment

Chaperones + Drivers will be charged $475. You MUST be 25+ to drive students and be considered as a chaperone + driver
Contact ebeauchamp, ebeauchamp@ourladyofangels.com, if you need balance due information.

Driver + Chaperone (25+)

Due January 9, 2027: $100 (Deposit)

Due February 5, 2027: $125 (Installment 1)

Due March 5, 2027: $125 (Installment 2)

Due April 9, 2027: $125 (Installment 3)

Total fee - $475

Are you willing to be a driver for the trip?

yes no I am a young adult and I will drive myself and I am open to driving other young adults

If willing to be a driver, please let me know how many you can fit in your car. NOTE! There MUST be 2 cleared adults in your car at all times PLUS willingness to get insurance in order to travel with minors.

Driver + Chaperone

Electronic Signature for Agreements

Name of person giving above consents

To make your electronic signature type your initials followed by 4 digits such as your date of birth or other unique ID number (EX: ABC1234)

Questions/Comments for YM Staff

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

May 31 - June 5, 2027

The location is Baton Rouge, Louisiana
Please fill out this form and click submit.

Payment Schedule:
Teens and Young Adults (ALL Young Adults MUST be Safe Environment cleared by the Diocese of Dallas):

Teens + Young Adults (18-20 OR Non-Chaperone YA)
Due January 9, 2027: $150 (Deposit)
Due February 5, 2027: $150 (Installment 1)
Due March 5, 2027: $150 (Installment 2)
Due April 9, 2027: $200 (Installment 3)

Total fee - $650

Chaperones

Chaperones age must be 21+ and safe environment cleared Therefore, the fee for them is $550.

Chaperone (21+)

Due January 9, 2027: $100 (Deposit)
Due February 5, 2027: $150 (Installment 1)
Due March 5, 2027: $150 (Installment 2)
Due April 9, 2027: $150 (Installment 3)
Total fee - $550

Driver + Chaperone (25+)

Chaperones + Drivers will be charged $475. You MUST be 25+ to drive students and be considered as a chaperone + driver

Driver Chaperone

Due January 9, 2027: $100 (Deposit)
Due February 5, 2027: $125 (Installment 1)
Due March 5, 2027: $125 (Installment 2)
Due April 9, 2027: $125 (Installment 3)

Total fee - $475

2027 Mission Trip Registration - ADULTS

Description

Please Fix the Following